Bob Luttman, Robert Luttman & Associates
Operational Issues: Documentation and Reporting
Traditional Pathway / Variance Documentation
What's Wrong With This Picture?
The Biggest Issue: So What?
The Big Issue: So What?
Scenario: You look over your quarterly variance report and notice that Physical Therapy is not doing their assessment on Day 4 thus generating variances on 25% of your patients. You meet with the PT Director and explain your data. She replies that staffing, space, budget, and El Nino all keep her from providing enough staff to do the assessments on weekdays/weekends/leap years/etc. In other words, take what you get. Or, "So what? Nothing I can do about it."
I have heard this scenario, or variations on it, many times. I usually side with the PT Director.
The issue is not the cause of the variances but their effect.
Remember last week:
What you need to focus on are effectiveness variances and the compliance variances that cause them. View your process through the lens of outcomes not tasks.
Unless you can show the effect of that PT Assessment variance (delayed discharge, lesser outcomes, higher costs, more readmissions, poor patient satisfaction) she is probably not going to address the issue. In these days of tighter budgets she may not have the capability to address the issue.
The simple histogram of variances (even a nice Pareto histogram) is not going to sell the PT Director nor her superiors to reorganize her processes or add resources to make that variance go away. You need to do a deeper analysis based on process and statistical knowledge.
